Teaching video-assisted thoracic surgery (VATS) lobectomy

Abstract

Video-assisted thoracic surgery (VATS) lobectomy has become the standard of care for early stage lung cancer throughout the world. Teaching this complex procedure requires adequate case volume, adequate instrumentation, a committed operating room team and baseline experience with open lobectomy. We outline what key maneuvers and steps are required to teach and learn VATS lobectomy. This is most easily performed as part of a thoracic surgery training program, but with adequate commitment and proctoring, there is no reason experienced open surgeons cannot become proficient VATS surgeons. We provide videos showing the key portions of a subcarinal lymph node dissection, posterior hilar dissection of the right upper lobe, fissureless right middle lobectomy, and fissureless left lower lobectomy. These videos highlight what we feel are important principals in VATS lobectomy, i.e., N2 and N1 lymph node dissection, fissureless techniques, and progressive responsibility of the learner. Current literature in simulation of VATS lobectomy is also outlined as this will be the future of teaching in VATS lobectomy.

Keywords: simulation; teaching; video-assisted thoracic surgery (VATS) lobectomy.

Figures

Video 1

Station 7 Lymph node dissection. We prefer to start our procedure with this posterior hilar dissection and removing N2 nodes during the initial dissection. The sub-carinal lymph nodes are removed as a packet whenever possible.

Video 2

Posterior dissection RUL Bronch and PA. The bronchus and first pulmonary artery branch are dissected and divided from the posterior approach. This may be necessary for large anterior tumors that prevent anterior visualization.

Video 3

Anterior approach to the RML. Right middle lobectomy is performed in a “Fissureless” technique, taking the hilar vessels and bronchus first, then the fissures to perform the lobectomy.

Video 4

Fissureless LLL. The key steps of a fissureless left lower lobectomy are shown. Smaller portions of the dissection are shown to keep the video short.